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- Now, I'm recording.

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Alright, so what are some factors

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that influence mental health?

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That's what we need to talk about.

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Mental health can change
over time, ask the questions,

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asking questions like are you anxious?

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What affects your mental health?

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Questions like that.

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Is their mood and their affect congruent?

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So, if they're really sad,

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is the affect,

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like what their facial
expression is showing,

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is it the same?

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Sometimes, you'll have
people who are really anxious

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and they're laughing, they're
smiling, laughing at you.

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Is it the same?

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Be knowledgeable about local resources

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and that's something you learn over time.

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And, if you don't know,

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what do you do?

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You ask.

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You ask if you suspect

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that your patient has
a mental health issue

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that's not diagnosed,

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you can always ask your nurse
that you're working with,

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your clinical instructor.

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How might substance use or
abuse influence mental health.

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For some people mental
health is exacerbated

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or made worse with drug abuse.

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I don't know if you've ever seen this,

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but like some people who abuse drugs,

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when they are abusing the drugs,

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they're just be really
angry, or paranoid, or...

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Or just anxious.

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I had a brother, he passed
away due to complications

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from an overdose,

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but he, whenever he was abusing drugs,

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he'd get really violent.

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He'd get really paranoid.

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So, what's affecting them.

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Cultural considerations.

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That's a big one.

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Social stigma.

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I don't wanna go into detail
about each of these things,

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but just know that that
can affect as well.

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Factors that may influence mental health,

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economic and social factors,
not having enough money,

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unhealthy lifestyles, drug abuse,

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being unhealthy as far
as food consumption.

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I think the big one is drug abuse.

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Exposure to violence or
trauma, that can really...

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Someone may not have
any mental health issues

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until they've had an experience
with violence or traumas.

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So, keep that in mind.

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Like what...

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What kind of...

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What was the originator?

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What caused this?

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Personality factors,

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spiritual or cultural factors
may also play into this,

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and you're gonna have a
full semester just on psych,

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and that's gonna kind of
go through all of this.

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Psychosocial development
impairments of neurological system.

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Maybe, they had a head injury

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and now their personality
is completely different.

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Genetics is another one.

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Depression is often seen in families,

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like a grandfather had
issues with depression.

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You may see it in the children as well,

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like the child and then the
grandchildren, potentially.

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We look at alert and
oriented times three or four.

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Some of you were asking
me about the times four,

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what does that mean?

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So, we have to ask questions.

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And, usually I ask this
when I come into the room,

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I say, I'm just gonna
look at your name band,

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can you tell me your
name and date of birth?

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And, I'm comparing what they say

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to what's on their name band.

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And, then at the same
time, I might say, oh,

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could you just tell me where
you are, and what year it is,

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or what the date is.

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And, you might also, the
times four is situation.

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Why are they in the hospital?

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And, I've seen this in the ICU
where they knew their name,

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they knew to date because we told them,

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they knew that they were in a hospital,

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but they didn't know why
they were in a hospital.

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So, just kind of asking
them that extra question,

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why are you here?

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Place, can you tell me where you are?

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Date, I mentioned all of this.

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Another thing that you might,

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and this isn't, they're
not quite oriented,

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but if they, you can say like,

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are you in a gas station,
a hospital, or a school?

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And, then they might be able
to pick the right answer

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from asking those questions.

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And, then, oh, just one
other thing I wanna mention

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is reorienting your patient, saying,

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asking them those questions,

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maybe they get it wrong.

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And, then just saying, so and so,

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just wanna remind you of the date.

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I just wanna remind you of where you are.

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And, I've done that with
patients over a 12 hour period,

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and by the time we get to the
end of the 12 hour period,

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they were able to answer all
these questions correctly.

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They just needed to be reoriented.

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Level of consciousness,
or L O C, capital L O C,

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is we look at these five
different levels of consciousness.

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Alert is they're in the room.

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Their eyes are open.

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They're looking around.

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They may still be confused,
but they're alert.

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Lethargic is you have to
go to them and kind of...

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Kind of maybe tap their shoulder
and say, hey, so and so,

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and they open their eyes.

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They're able to answer
the questions correctly,

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but they fall back asleep

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and that could be due
to a metabolic issue.

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It could be due to sedation.

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It could be due to a head injury.

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There's a lot of reasons,

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but we're just looking, are they alert?

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Are they lethargic?

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Obtunded,

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obtunded is you go in the room

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and you're like yelling their name,

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and they're able to open their eyes.

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They respond slowly with
some confusion usually.

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And, they're aware of the
environment, potentially.

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Stuporous, awakens to vigorous shaking.

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You have to really wake them up.

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You might have to take your knuckle

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and go over their sternum
and rub like this.

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That's why it talks about painful stimuli.

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You're causing that painful...

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I don't know if you...

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You should do it to yourself.

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Just take your knuckle and
just rub over your sternum.

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It's, it can be, it's pretty painful.

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Painful stimuli may return
to unresponsive sleep.

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And, then comatosed, remains
unresponsive to all stimuli,

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eyes stay closed.

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Now, it can be comatosed for a little bit,

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maybe 'cause they had a lot of sedation,

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but if it's sedation related, it should...

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They should improve once
the sedation wears off,

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but it can also occur due
to metabolic disorders.

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It can occur due to head injury.

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I've seen all of this, so...

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So, this is really important.

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This slide I'm gonna say is
really, really important.

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Do you wanna highlight this slide?

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I'm not gonna go into dementia
versus delirium too much,

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but dementia is usually

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when we look at like Alzheimer's
versus vascular dementia.

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Is it like a pathological disorder

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versus vascular dementia could be like...

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My grandfather had this.

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Basically, he had all these micro strokes

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and it caused what we
call vascular dementia.

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It can usually, dementia is
usually chronic, irreversible,

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which is the key word there.

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They have memory loss,
challenges with planning,

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problem solving,

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they can't do ADLs, changes in mood.

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Delirium is a little bit different.

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It can, they can show the signs
of dementia with delirium.

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It is reversible with treatment
of underlying condition,

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review the chart in your text.

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So, sometimes we have older patients

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that come into the hospital

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and we are doing all these things to them.

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We're giving them meds.

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We're...

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They're not in their normal environment.

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They are not sleeping.

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You think in the
hospital, you would sleep,

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but that doesn't happen all the time.

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So, they're really tired.

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They become delirious

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and they kind of act
like they have dementia,

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but once we know, maybe, we
take the medication away,

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we allow them to sleep.

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We treat the underlying condition.

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For example, maybe they have
a UTI and we treat that.

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Then, it goes away, the delirium.

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So, and you're gonna learn more

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about the treatment of older patients

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when you take gerontology in the fall.

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So, I'm not gonna talk too much

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about what's on the
right side of this slide.

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I'm gonna focus more on the left side,

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but just know that if you're
taking care of someone,

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there is your general assessment,

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and then there's your
more focused assessment.

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So, general routine screening
versus focused assessment,

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so your general routine screening

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of someone's neurological status,

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I don't care if you're
in the postpartum unit,

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or if you're on the psych unit,

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or if you're on a med surg unit,

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we have general assessments.

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So, level of consciousness,
are they alert?

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Are they lethargic? Are they stuporous?

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Posture? Is their posture erect?

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Is it slouched? Is it uneven?

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Their gait, that's their ability to walk.

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We'll talk more about
that, body movements,

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do they have extra twitching?

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Behavior and affect, are
they crying constantly,

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despite what's happening around them?

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Are they laughing hysterically?

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What's going on there?

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Screen for tobacco, ETOH, illicit drugs.

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People can have really extreme behavior

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when they are, or seizures too,

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when they are withdrawing from drugs.

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So, just keep that in mind,

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observe their dress and grooming.

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Someone with a mental status issue

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or mental status diagnosis
might have, be...

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Have dress that's poorly
kept, dirty, poor grooming,

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observe facial expressions,

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assess speech, orientation, concentration.

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Are they able to concentrate?

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Are they oriented?

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Is their speech kind
of, does it make sense

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or is it, does it not make sense?

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The opposite would,
does it not make sense?

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Assess memory, thought
process, perception.

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I've had patients that
were really paranoid.

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They were thinking someone's
gonna come kill them.

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It wasn't true,

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but because of their mental health status,

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they were really believing that.

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They really felt like
someone was gonna kill them,

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and if you feel like
someone's gonna kill you,

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you're gonna be anxious, right?

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You're gonna be afraid.

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That might escalate.

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So, clinical pearls,

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speech is influenced by
experience, level of education,

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and culture.

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So, when you're assessing
someone's speech, is it clear?

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Is it, what's their
educational background?

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What's their cultural background?

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Is this their first
language, second language,

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third language?

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Where do they fall in all of that?

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Eye contact, facial expressions

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may defer in various cultures.

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There's some cultures
that would consider it,

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I know in Africa,

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there's a few cultures there

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that would consider it extremely rude

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for you to maintain eye contact.

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So, knowing your patient's
cultural background is important,

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your client may or may not
be a reliable historian.

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That's a big one right there.

263
00:11:34,130 --> 00:11:36,310
Your patient may be pleasant,,

264
00:11:36,310 --> 00:11:38,160
but they may not be able to tell you

265
00:11:38,160 --> 00:11:42,214
that they have diabetes or
hypertension, or they...

266
00:11:42,214 --> 00:11:43,690
You're maybe relying on their kids

267
00:11:43,690 --> 00:11:48,033
or their caregiver to give
you accurate information.

268
00:11:49,070 --> 00:11:52,040
And, then monitoring
environment and distractions.

269
00:11:52,040 --> 00:11:55,160
Some patients, if they
have a certain caregiver,

270
00:11:55,160 --> 00:11:56,700
with a certain personality,

271
00:11:56,700 --> 00:12:01,230
or maybe there's a lot
of lights on your unit,

272
00:12:01,230 --> 00:12:02,440
or there's a lot of noise,

273
00:12:02,440 --> 00:12:05,433
that can cause an escalation in behavior.

274
00:12:06,550 --> 00:12:09,220
So, just kind of observing your patient.

275
00:12:09,220 --> 00:12:11,940
What makes them more anxious?
What makes them less anxious?

276
00:12:11,940 --> 00:12:12,860
Trying to figure out,

277
00:12:12,860 --> 00:12:15,070
and sometimes your patient
can't even tell you

278
00:12:15,070 --> 00:12:17,030
what's going on.

279
00:12:17,030 --> 00:12:20,510
They're just so anxious or they have...

280
00:12:20,510 --> 00:12:22,810
Their mental health is in such a state

281
00:12:22,810 --> 00:12:23,870
that they can't tell you.

282
00:12:23,870 --> 00:12:27,013
So, being observant,
watching the environment,

283
00:12:29,371 --> 00:12:31,940
what is a trigger for them?

284
00:12:31,940 --> 00:12:33,430
So, and it could be tricky.

285
00:12:33,430 --> 00:12:35,850
It's almost like a puzzle
trying to figure out

286
00:12:35,850 --> 00:12:39,333
what makes that patient more
comfortable, less comfortable.

287
00:12:42,455 --> 00:12:47,455
GCS, so GCS is something
you really need to grasp.

288
00:12:48,060 --> 00:12:48,893
It's a...

289
00:12:48,893 --> 00:12:52,660
It's helps us determine
injury to the brain.

290
00:12:52,660 --> 00:12:55,483
It helps us determine
level of consciousness.

291
00:12:56,530 --> 00:12:58,950
So, the first part of it is eye opening,

292
00:12:58,950 --> 00:13:01,300
the second part is verbal response,

293
00:13:01,300 --> 00:13:02,720
and then motor response.

294
00:13:02,720 --> 00:13:04,860
So, do you, when you walk into the room,

295
00:13:04,860 --> 00:13:06,380
are their eyes already open?

296
00:13:06,380 --> 00:13:08,740
They get a four points for that.

297
00:13:08,740 --> 00:13:11,230
If you come in the room
and you ask them something,

298
00:13:11,230 --> 00:13:12,130
or you say their name,

299
00:13:12,130 --> 00:13:15,710
do they open their eyes
to you talking to them?

300
00:13:15,710 --> 00:13:18,380
Sometimes, you have to cause some pain,

301
00:13:18,380 --> 00:13:20,920
like I was talking about the sternal rub

302
00:13:20,920 --> 00:13:22,510
to have them open their eyes.

303
00:13:22,510 --> 00:13:24,948
Maybe, they're really sedated.

304
00:13:24,948 --> 00:13:25,781
They have a lot of medication.

305
00:13:25,781 --> 00:13:29,750
And, then the other one is
no opening, no eye opening.

306
00:13:29,750 --> 00:13:32,090
Verbal response, are they oriented?

307
00:13:32,090 --> 00:13:36,960
Number two, are they confused
when you ask them questions,

308
00:13:36,960 --> 00:13:40,030
inappropriate response,
maybe you're saying,

309
00:13:40,030 --> 00:13:41,390
how are you doing?

310
00:13:41,390 --> 00:13:44,410
And, they're like the
weather, and the table,

311
00:13:44,410 --> 00:13:47,110
and it doesn't make sense.

312
00:13:47,110 --> 00:13:49,560
The other one, incomprehensible
sound or speech,

313
00:13:49,560 --> 00:13:51,540
especially with someone
who has had a stroke,

314
00:13:51,540 --> 00:13:52,820
they might be moaning.

315
00:13:52,820 --> 00:13:55,883
They might be groaning
when you talk to them.

316
00:13:55,883 --> 00:13:58,970
And, sometimes that
clears up, it gets better,

317
00:13:58,970 --> 00:14:00,370
or it can become worse.

318
00:14:00,370 --> 00:14:01,500
They become non-verbal.

319
00:14:01,500 --> 00:14:03,080
So, that would be
something you would report

320
00:14:03,080 --> 00:14:05,280
if it goes backwards.

321
00:14:05,280 --> 00:14:07,660
They're also non-verbal
if they're intubated,

322
00:14:07,660 --> 00:14:09,433
if they have a breathing tube in.

323
00:14:11,530 --> 00:14:14,000
The next one is motor response,
do they obey commands?

324
00:14:14,000 --> 00:14:16,030
If you ask them to squeeze your hands

325
00:14:16,030 --> 00:14:19,160
or push down on the pedal,
when you do the dorsa flection,

326
00:14:19,160 --> 00:14:20,850
and plantar flection.

327
00:14:20,850 --> 00:14:22,300
Are they able to do that?

328
00:14:22,300 --> 00:14:23,500
Maybe, they're confused,

329
00:14:23,500 --> 00:14:25,323
but they're able to follow commands.

330
00:14:26,180 --> 00:14:28,200
Purposeful movement to painful stimulus.

331
00:14:28,200 --> 00:14:33,200
That would be like, let's
say I pinch their right.

332
00:14:34,110 --> 00:14:35,290
This is my left shoulder.

333
00:14:35,290 --> 00:14:37,440
If I pinch their left shoulder,

334
00:14:37,440 --> 00:14:41,570
are they able to take their
hand and like push you away?

335
00:14:41,570 --> 00:14:44,150
Do they, are they purposeful?

336
00:14:44,150 --> 00:14:46,850
And, that's purposeful,
they're able to push you away.

337
00:14:47,820 --> 00:14:50,220
The next one is withdrawals from pain.

338
00:14:50,220 --> 00:14:51,110
That would be like,

339
00:14:51,110 --> 00:14:53,690
I would do this on all four extremities,

340
00:14:53,690 --> 00:14:55,210
but I would take a, maybe a pen,

341
00:14:55,210 --> 00:14:58,140
or we usually do a pen.

342
00:14:58,140 --> 00:15:00,520
And, I don't know if you
can see what I'm doing,

343
00:15:00,520 --> 00:15:02,750
I'm taking the pen and I'm
putting it over my nail bed,

344
00:15:02,750 --> 00:15:04,240
and then I'm pinching,

345
00:15:04,240 --> 00:15:06,890
and you should do that to
yourself to see how it feels,

346
00:15:06,890 --> 00:15:08,110
but I'm doing that.

347
00:15:08,110 --> 00:15:10,760
And, what you want them
to do is pull away,

348
00:15:10,760 --> 00:15:14,763
they should be able to pull
away from that painful stimulus.

349
00:15:16,590 --> 00:15:18,540
And, then we'll talk about decorticate

350
00:15:18,540 --> 00:15:20,670
and decerebrate posturing.

351
00:15:20,670 --> 00:15:24,713
That's typically with a
really bad pain head injury,

352
00:15:26,060 --> 00:15:27,110
not a good sign.

353
00:15:27,110 --> 00:15:27,943
We'll talk about that.

354
00:15:27,943 --> 00:15:29,940
And, then no motor response.

355
00:15:29,940 --> 00:15:31,060
So, if you look at the bottom,

356
00:15:31,060 --> 00:15:33,180
it says minor brain injury,

357
00:15:33,180 --> 00:15:34,230
and it's not always an injury.

358
00:15:34,230 --> 00:15:36,210
It could be like sedation.

359
00:15:36,210 --> 00:15:38,120
It would be 13 to 15 points.

360
00:15:38,120 --> 00:15:40,630
Moderate brain injury
is nine to 12 points.

361
00:15:40,630 --> 00:15:43,780
And, then severe brain
injury is three to eight.

362
00:15:43,780 --> 00:15:47,880
A person who is dead will
get three points, right?

363
00:15:47,880 --> 00:15:51,030
So, it's good to know their GCS,

364
00:15:51,030 --> 00:15:53,730
when a patient's coming in into the ED,

365
00:15:53,730 --> 00:15:56,870
or if they're coming from the ED to you,

366
00:15:56,870 --> 00:16:00,173
what's their GCs, what was
their GCs upon arrival?

367
00:16:01,240 --> 00:16:03,483
Has it gotten worse? Has it gotten better?

368
00:16:05,060 --> 00:16:07,720
Typically, for me, in the
ICU, when I'm working,

369
00:16:07,720 --> 00:16:11,370
we do neuro assessments every hour.

370
00:16:11,370 --> 00:16:14,350
So, every hour, from one hour to the next,

371
00:16:14,350 --> 00:16:19,350
I'm assessing what is their
GCS from one hour to the next,

372
00:16:19,960 --> 00:16:20,810
has it changed?

373
00:16:20,810 --> 00:16:22,380
Has it improved?

374
00:16:22,380 --> 00:16:24,480
If it's changed, why has it changed?

375
00:16:24,480 --> 00:16:26,540
Do I need to call the doctor about that?

376
00:16:26,540 --> 00:16:29,210
For the floor nursing,
it's every four hours

377
00:16:29,210 --> 00:16:30,350
to every eight hours.

378
00:16:30,350 --> 00:16:32,847
So, if you're doing it every four hours,

379
00:16:32,847 --> 00:16:36,490
you wanna compare to four hours prior,

380
00:16:36,490 --> 00:16:38,390
or the last time you saw that patient,

381
00:16:39,720 --> 00:16:44,240
here's a picture of decerebrate
and decorticate posturing.

382
00:16:44,240 --> 00:16:46,670
And, it, I'm not gonna read through this,

383
00:16:46,670 --> 00:16:47,780
but you can read through it.

384
00:16:47,780 --> 00:16:50,010
And, so if they're doing this,

385
00:16:50,010 --> 00:16:52,860
they're kind of posturing like so,

386
00:16:52,860 --> 00:16:56,100
that's more of a upper brain stem damage.

387
00:16:56,100 --> 00:16:57,230
Oops, sorry.

388
00:16:57,230 --> 00:17:02,070
And, then the opposite would be damage

389
00:17:02,070 --> 00:17:05,160
to one or both corticospinal tracts, okay.

390
00:17:05,160 --> 00:17:07,963
So, I have only seen this a few times.

391
00:17:09,100 --> 00:17:11,090
It was on a patient,

392
00:17:11,090 --> 00:17:12,850
patients who've had head injuries

393
00:17:12,850 --> 00:17:14,820
and they were about to go to surgery.

394
00:17:14,820 --> 00:17:16,220
And, then when they
came back from surgery,

395
00:17:16,220 --> 00:17:17,900
they were not doing this anymore.

396
00:17:17,900 --> 00:17:22,900
So, you might see this and
it's not a good sign, okay?

397
00:17:24,700 --> 00:17:27,130
Neurological system, I'm not
gonna go into great detail,

398
00:17:27,130 --> 00:17:30,720
but you should know the
different parts of the brain,

399
00:17:30,720 --> 00:17:35,050
the different parts of the
spinal column, the brain stem,

400
00:17:35,050 --> 00:17:35,883
all that.

401
00:17:35,883 --> 00:17:36,770
You should know that.

402
00:17:39,020 --> 00:17:40,700
Again, I'm not gonna go into great detail,

403
00:17:40,700 --> 00:17:43,300
but this talks about the
understanding the different...

404
00:17:43,300 --> 00:17:45,410
So, if they have a frontal head injury

405
00:17:45,410 --> 00:17:50,360
or a parietal head injury,
an occipital head injury,

406
00:17:50,360 --> 00:17:51,850
or temporal head injury,

407
00:17:51,850 --> 00:17:54,110
that's gonna affect different parts

408
00:17:54,110 --> 00:17:58,490
of their neurological muscular function.

409
00:17:58,490 --> 00:18:01,410
So, this is something you
would, you wanna know,

410
00:18:01,410 --> 00:18:02,460
might be on the test.

411
00:18:04,083 --> 00:18:06,160
So, if a kid gets hit in the head,

412
00:18:06,160 --> 00:18:07,820
like the occipital area,

413
00:18:07,820 --> 00:18:09,830
that might affect their vision, right?

414
00:18:09,830 --> 00:18:12,160
It might affect their
reading and understanding.

415
00:18:12,160 --> 00:18:15,070
If their frontal area is hit,

416
00:18:15,070 --> 00:18:19,250
that might affect their
speech and all that.

417
00:18:19,250 --> 00:18:21,850
So, just understanding
all of those concepts,

418
00:18:21,850 --> 00:18:24,423
and I could give you story,
after story, after story

419
00:18:24,423 --> 00:18:26,877
of different head injuries that I've seen

420
00:18:26,877 --> 00:18:29,030
and the loss of function.

421
00:18:29,030 --> 00:18:31,850
And, sometimes people regain function.

422
00:18:31,850 --> 00:18:36,010
Sometimes, the initial
injury, plus the swelling

423
00:18:36,010 --> 00:18:38,023
causes someone to lose function,

424
00:18:39,090 --> 00:18:42,010
and then they regain it
once the swelling goes down.

425
00:18:42,010 --> 00:18:45,260
So, it can look really scary at first

426
00:18:45,260 --> 00:18:48,060
when you see a brain injury,

427
00:18:48,060 --> 00:18:50,970
but keep in mind that sometimes
it's the initial swelling

428
00:18:50,970 --> 00:18:53,110
that makes it look bad.

429
00:18:53,110 --> 00:18:55,060
And, we try to treat that swelling.

430
00:18:55,060 --> 00:18:57,640
We don't want the swelling to get worse.

431
00:18:57,640 --> 00:19:00,460
If they have a bleed, we don't
want that bleed to get worse.

432
00:19:00,460 --> 00:19:02,860
And, hopefully all of that kind of...

433
00:19:04,180 --> 00:19:06,400
The swelling goes down
and then they improve.

434
00:19:06,400 --> 00:19:08,200
And, then their function comes back.

435
00:19:10,410 --> 00:19:12,390
Central versus peripheral nervous system.

436
00:19:12,390 --> 00:19:14,980
So, your central is just
giving you the distinction

437
00:19:14,980 --> 00:19:16,120
between the two.

438
00:19:16,120 --> 00:19:17,570
I would know this.

439
00:19:17,570 --> 00:19:20,313
I'm not gonna go into the
detail about all of this.

440
00:19:21,630 --> 00:19:23,770
Just another breakdown
of the nervous system.

441
00:19:23,770 --> 00:19:26,462
The nervous system is so fascinating.

442
00:19:26,462 --> 00:19:28,930
I could talk about this for hours,

443
00:19:28,930 --> 00:19:32,300
one, because I work in surgical ICU

444
00:19:32,300 --> 00:19:37,140
and we have part of our
surgical ICU is the neuro ICU.

445
00:19:37,140 --> 00:19:40,780
So, I've seen a lot of
injuries to different parts

446
00:19:40,780 --> 00:19:42,610
of the neuro system.

447
00:19:42,610 --> 00:19:46,730
One thing I wanna say is it takes,

448
00:19:46,730 --> 00:19:50,310
a neuro nurse needs to
be very detail oriented,

449
00:19:50,310 --> 00:19:51,960
needs to be very...

450
00:19:53,670 --> 00:19:58,320
Just be able to pick up on subtle changes,

451
00:19:58,320 --> 00:20:00,140
because it's those subtle changes

452
00:20:00,140 --> 00:20:02,633
that can be indicative of something worse,

453
00:20:03,470 --> 00:20:05,190
that something worse might be happening.

454
00:20:05,190 --> 00:20:07,280
So, if you're like someone
who's really detail oriented,

455
00:20:07,280 --> 00:20:11,880
you really love how
the neuro system works,

456
00:20:11,880 --> 00:20:14,240
this might be your specialty.

457
00:20:14,240 --> 00:20:16,423
So, keep that in mind for the future.

458
00:20:17,570 --> 00:20:19,230
Common neurological problems,

459
00:20:19,230 --> 00:20:21,920
I'm not gonna go into
detail about each of these.

460
00:20:21,920 --> 00:20:24,560
Headaches is one, we
think about headaches,

461
00:20:24,560 --> 00:20:25,700
oh, everybody has headaches,

462
00:20:25,700 --> 00:20:27,500
but not everybody has headaches.

463
00:20:27,500 --> 00:20:28,830
And, headaches can tell us a lot

464
00:20:28,830 --> 00:20:31,640
about how the head is doing.

465
00:20:31,640 --> 00:20:32,880
If someone has a head injury

466
00:20:32,880 --> 00:20:34,430
and they have a headache,

467
00:20:34,430 --> 00:20:36,060
that can tell us,

468
00:20:36,060 --> 00:20:38,500
is the swelling in the head getting worse?

469
00:20:38,500 --> 00:20:40,330
Seizures, not a good sign,

470
00:20:40,330 --> 00:20:42,670
but that can tell us
also how they're doing.

471
00:20:42,670 --> 00:20:46,090
Dizziness, numbness, and
tingling in the hands feet.

472
00:20:46,090 --> 00:20:48,970
Again, not good.

473
00:20:48,970 --> 00:20:51,360
If it gets worse, you
would wanna report that.

474
00:20:51,360 --> 00:20:53,973
If it's a new finding,
you wanna report that.

475
00:20:55,080 --> 00:20:57,390
Any changes in the five senses.

476
00:20:57,390 --> 00:21:00,720
I know, with COVID, we talk
about loss of taste or smell,

477
00:21:00,720 --> 00:21:02,110
but I had a...

478
00:21:02,110 --> 00:21:03,940
Some patients will have strokes,

479
00:21:03,940 --> 00:21:05,300
not strokes, but like...

480
00:21:06,250 --> 00:21:07,310
I'm not a neurologist,

481
00:21:07,310 --> 00:21:09,390
but they have these kind of seizures

482
00:21:09,390 --> 00:21:12,270
that makes them smell burnt toast.

483
00:21:12,270 --> 00:21:14,070
And, if they smell that burn toast,

484
00:21:14,070 --> 00:21:16,520
we need to call the doctor
for them to be treated.

485
00:21:16,520 --> 00:21:19,090
So, it just depends you know.

486
00:21:19,090 --> 00:21:23,690
A loss of taste, loss of smell, all that.

487
00:21:23,690 --> 00:21:26,280
Difficulty swallowing, speaking.

488
00:21:26,280 --> 00:21:28,890
We think about the word dysphasia.

489
00:21:28,890 --> 00:21:31,296
Is that because of a stroke,

490
00:21:31,296 --> 00:21:32,670
a neurological problem?

491
00:21:32,670 --> 00:21:37,670
Falls, big falls, if your
patient is prone to fall,

492
00:21:38,380 --> 00:21:42,680
they are at risk for head injuries, okay?

493
00:21:42,680 --> 00:21:47,680
Head injuries is huge, especially
in your older population.

494
00:21:48,790 --> 00:21:51,850
So, if this is someone
who is prone to falls,

495
00:21:51,850 --> 00:21:52,683
it's some...

496
00:21:52,683 --> 00:21:53,516
This is someone that

497
00:21:53,516 --> 00:21:57,780
you're gonna want to see
occupational therapy,

498
00:21:57,780 --> 00:21:59,170
physical therapy.

499
00:21:59,170 --> 00:22:00,660
You wanna keep them safe.

500
00:22:00,660 --> 00:22:03,030
You don't want them hitting their head.

501
00:22:03,030 --> 00:22:05,350
Change in cognition or memory,

502
00:22:05,350 --> 00:22:07,720
picking up on that is important,

503
00:22:07,720 --> 00:22:10,180
to see what's going on,
what's causing this.

504
00:22:10,180 --> 00:22:12,123
In a younger person,

505
00:22:13,336 --> 00:22:15,180
if they haven't had a trauma,

506
00:22:15,180 --> 00:22:18,210
and they suddenly lose
memory, or cognition,

507
00:22:18,210 --> 00:22:19,980
or have neurological changes,

508
00:22:19,980 --> 00:22:23,460
it could be a lot of things.

509
00:22:23,460 --> 00:22:25,100
But, one of the things I often see

510
00:22:25,100 --> 00:22:26,480
is it could be a tumor.

511
00:22:26,480 --> 00:22:29,113
So, taking that seriously.

512
00:22:30,710 --> 00:22:31,620
Muscle control,

513
00:22:31,620 --> 00:22:35,480
if they start having fasciculations,

514
00:22:35,480 --> 00:22:39,650
it's like sudden quick
movements, tremors, ticks,

515
00:22:39,650 --> 00:22:41,640
myoclonus, or chorea,

516
00:22:41,640 --> 00:22:44,573
all of that is in your term sheets,

517
00:22:45,710 --> 00:22:48,743
but sudden muscle, loss of muscle...

518
00:22:50,620 --> 00:22:53,110
Sudden loss of muscle control

519
00:22:53,110 --> 00:22:55,550
needs to be investigated, okay?

520
00:22:55,550 --> 00:22:57,450
I don't care if it's young, old,

521
00:22:57,450 --> 00:22:58,690
it needs to be investigated.

522
00:22:58,690 --> 00:23:00,390
Better figure out what's going on.

523
00:23:01,970 --> 00:23:03,500
Talk about strokes.

524
00:23:03,500 --> 00:23:06,400
So, there's different
types of strokes, okay?

525
00:23:06,400 --> 00:23:08,660
I don't know if you know this,
maybe this is new to you,

526
00:23:08,660 --> 00:23:10,630
or you're like, you know
what, that's old news,

527
00:23:10,630 --> 00:23:13,010
but blood flow to the part
of your brain is blocked

528
00:23:13,010 --> 00:23:13,843
or interrupted,

529
00:23:13,843 --> 00:23:16,810
depriving the brain of oxygen.

530
00:23:16,810 --> 00:23:21,810
So, an ischemic stroke is
usually caused by a clot,

531
00:23:21,930 --> 00:23:23,630
a brain clot.

532
00:23:23,630 --> 00:23:27,120
A hemorrhagic stroke can happen
for a variety of reasons,

533
00:23:27,120 --> 00:23:29,173
maybe an aneurysm ruptured.

534
00:23:31,460 --> 00:23:34,140
They, maybe they're on blood thinners

535
00:23:34,140 --> 00:23:36,340
and that caused some bleed, bleeding.

536
00:23:36,340 --> 00:23:40,200
TIA is a transient ischemic attack.

537
00:23:40,200 --> 00:23:43,870
They lost blood flow for
a short period of time

538
00:23:43,870 --> 00:23:45,480
in the brain.

539
00:23:45,480 --> 00:23:47,650
Usually, could be a...

540
00:23:47,650 --> 00:23:49,160
And, I don't wanna go into great detail,

541
00:23:49,160 --> 00:23:53,640
but could be a sign of an
impending, severe ischemic stroke.

542
00:23:53,640 --> 00:23:55,940
So, there's different types of strokes.

543
00:23:55,940 --> 00:23:59,070
You're learn more about them
when you go to pathophysiology

544
00:23:59,070 --> 00:24:00,540
and med surg classes.

545
00:24:00,540 --> 00:24:02,410
But, I just wanna talk about that.

546
00:24:02,410 --> 00:24:05,710
Strokes are a medical emergency, okay?

547
00:24:05,710 --> 00:24:08,320
I've talked about time is tissue.

548
00:24:08,320 --> 00:24:12,180
So, the faster you treat these ischemic

549
00:24:12,180 --> 00:24:14,400
or hemorrhagic strokes,

550
00:24:14,400 --> 00:24:18,060
the less damage the patient
might potentially have.

551
00:24:18,060 --> 00:24:20,350
Know the signs and symptoms of strokes.

552
00:24:20,350 --> 00:24:23,190
Know the risk factors
for strokes, act fast,

553
00:24:23,190 --> 00:24:24,950
time is brain.

554
00:24:24,950 --> 00:24:25,800
I see a question.

555
00:24:32,410 --> 00:24:37,410
- Sarah, there's a question
regarding the types of strokes.

556
00:24:37,600 --> 00:24:41,690
Just, what are the causes
for ischemic strokes?

557
00:24:41,690 --> 00:24:46,260
- Clots, like maybe they...

558
00:24:46,260 --> 00:24:47,820
There's, oh, there's a lot of reasons.

559
00:24:47,820 --> 00:24:49,600
Maybe, they have like AFIB,

560
00:24:49,600 --> 00:24:51,560
and that produced a clot in the heart

561
00:24:51,560 --> 00:24:53,010
that went to the brain.

562
00:24:53,010 --> 00:24:54,900
Maybe, they had a clot in their leg

563
00:24:54,900 --> 00:24:58,313
that traveled up to their brain.

564
00:24:59,270 --> 00:25:01,003
Lots of reasons, so.

565
00:25:02,830 --> 00:25:05,180
Maybe, their blood
pressure dropped suddenly

566
00:25:05,180 --> 00:25:09,070
and that caused some spasming
of the vessels in the brain.

567
00:25:09,070 --> 00:25:11,470
And, that decreased the
blood flow to the brain.

568
00:25:12,440 --> 00:25:13,400
There's a lot of reasons.

569
00:25:13,400 --> 00:25:15,500
So, I see another question, Dan,

570
00:25:15,500 --> 00:25:16,333
Do you know?

571
00:25:21,570 --> 00:25:22,403
I dunno.

572
00:25:23,810 --> 00:25:25,160
- Sorry, it just said thank you.

573
00:25:25,160 --> 00:25:26,610
There's no other question.

574
00:25:26,610 --> 00:25:31,610
- Okay, stroke facts, up
to 80% are preventable.

575
00:25:31,630 --> 00:25:34,130
Treatment is available if we act FAST.

576
00:25:34,130 --> 00:25:35,950
That's an acronym we're
about to talk about.

577
00:25:35,950 --> 00:25:38,700
Stroke can happen to anyone at any time.

578
00:25:38,700 --> 00:25:41,120
Stroke is a brain attack, okay?

579
00:25:41,120 --> 00:25:42,970
It affects the brain.

580
00:25:42,970 --> 00:25:47,373
May have no residual
symptoms or severe sequalae?

581
00:25:48,960 --> 00:25:50,360
I can't say that word very well.

582
00:25:50,360 --> 00:25:51,403
Dan, can you say it?

583
00:25:56,238 --> 00:25:57,913
- Yeah, it's sequalae.

584
00:25:57,913 --> 00:26:00,537
- Okay, good. Thank you.

585
00:26:00,537 --> 00:26:02,290
For stroke, it just means

586
00:26:05,150 --> 00:26:08,550
maybe neurological muscular
changes due to the stroke.

587
00:26:08,550 --> 00:26:10,750
So, sometimes the symptoms go away.

588
00:26:10,750 --> 00:26:13,110
They regain full function over time.

589
00:26:13,110 --> 00:26:15,290
Not, it's not like instantaneous,

590
00:26:15,290 --> 00:26:17,580
and sometimes they remain...

591
00:26:18,560 --> 00:26:21,050
They continue to have
like left sided weakness,

592
00:26:21,050 --> 00:26:22,233
even after the stroke.

593
00:26:23,150 --> 00:26:25,020
It can also lead to a death.

594
00:26:25,020 --> 00:26:26,720
I've seen that happen.

595
00:26:26,720 --> 00:26:29,890
Stroke is the fifth leading
cause of death in the US.

596
00:26:29,890 --> 00:26:32,200
Family history of stroke
increases the client's risk,

597
00:26:32,200 --> 00:26:34,863
history of stroke increases
the client's risk, okay?

598
00:26:36,485 --> 00:26:37,820
And, I'm gonna take a break right here.

599
00:26:37,820 --> 00:26:40,160
I'm gonna stop recording, just a minute.

600
00:26:40,160 --> 00:26:41,003
Stop share.

601
00:26:42,390 --> 00:26:43,690
And, I'm gonna give you...

602
00:27:26,364 --> 00:27:27,680
Is anybody listening?

603
00:27:27,680 --> 00:27:29,000
I'm just wondering if...

604
00:27:29,850 --> 00:27:31,360
I know we have a respite day next week.

605
00:27:31,360 --> 00:27:35,903
Is PRNU 1-14 doing virtual?

606
00:27:38,370 --> 00:27:40,290
I don't know if they're out there.

607
00:27:40,290 --> 00:27:43,390
- I don't think we've heard
anything about that quite yet.

608
00:27:43,390 --> 00:27:44,913
- Okay, thank you.

609
00:27:46,690 --> 00:27:49,731
- At least I haven't.
Somebody else might have.

610
00:27:49,731 --> 00:27:50,564
- Okay.

611
00:27:52,718 --> 00:27:54,390
I'm just curious if
they were doing virtual.

612
00:27:54,390 --> 00:27:56,033
I can ask Carrie, easily.

613
00:27:58,290 --> 00:27:59,950
I'll just text her real quick.

614
00:27:59,950 --> 00:28:01,730
I have another minute.

615
00:28:01,730 --> 00:28:03,690
- [Viewer] When is the rest day?

616
00:28:03,690 --> 00:28:04,850
- Hmm?

617
00:28:04,850 --> 00:28:07,240
Oh, it's Thursday, the...

618
00:28:07,240 --> 00:28:08,073
What is it?

619
00:28:11,170 --> 00:28:12,113
The 15th.

620
00:28:13,830 --> 00:28:14,880
- [Viewer] Thank you.

621
00:28:29,690 --> 00:28:32,410
- So, you had said our first
simulation was next week,

622
00:28:32,410 --> 00:28:33,243
right?

623
00:28:33,243 --> 00:28:34,076
- Correct.

624
00:28:34,076 --> 00:28:36,210
- For us that are on,
have lab on Thursdays,

625
00:28:36,210 --> 00:28:38,880
will we just sign up for
slots on different days then?

626
00:28:38,880 --> 00:28:40,220
'Cause it's the respite day.

627
00:28:40,220 --> 00:28:41,440
- So, you'll have your respite day.

628
00:28:41,440 --> 00:28:42,320
No, you don't have to.

629
00:28:42,320 --> 00:28:46,340
So, what we're gonna do is
Dan's gonna help me on that day.

630
00:28:46,340 --> 00:28:50,040
And, then we're one of, probably me,

631
00:28:50,040 --> 00:28:54,330
will help Robin on Thursday
evening, the following week,

632
00:28:54,330 --> 00:28:56,423
and you'll do two simulations.

633
00:28:58,380 --> 00:28:59,213
- Okay.

634
00:28:59,213 --> 00:29:01,620
So, we each have both on the
week of the 22nd instead?

635
00:29:01,620 --> 00:29:03,154
- Yeah.

636
00:29:03,154 --> 00:29:06,540
'Cause, I don't want you guys to miss out,

637
00:29:06,540 --> 00:29:08,810
but I can't give you
extra work for the week.

638
00:29:08,810 --> 00:29:09,643
So...

639
00:29:13,070 --> 00:29:14,370
'Cause of the respite day.

640
00:29:21,310 --> 00:29:24,950
And, if anybody's
listening, the first week,

641
00:29:24,950 --> 00:29:27,510
it's therapeutic communication.

642
00:29:27,510 --> 00:29:30,470
So, it's really like to wet your whistle,

643
00:29:30,470 --> 00:29:31,850
to dip your toe in the water,

644
00:29:31,850 --> 00:29:36,530
to kind of get used to simulation.

645
00:29:36,530 --> 00:29:39,580
And, I'll talk about that
in my short, short video

646
00:29:39,580 --> 00:29:40,630
about simulation.

647
00:29:40,630 --> 00:29:41,890
Simulation's really fun.

648
00:29:41,890 --> 00:29:43,833
I've had to engage in simulation.

649
00:29:45,228 --> 00:29:48,040
And, even for me, I know it's not real,

650
00:29:48,040 --> 00:29:50,640
but you get into it.

651
00:29:50,640 --> 00:29:52,710
If you let yourself get, kind of,

652
00:29:52,710 --> 00:29:56,210
realize this is not a real patient,

653
00:29:56,210 --> 00:29:58,053
but I'm going to learn something,

654
00:29:59,530 --> 00:30:03,693
it allows you to kind of play the role.

655
00:30:05,330 --> 00:30:09,290
I've done this for ACLS
training, BLS training.

656
00:30:09,290 --> 00:30:12,290
I've done this for, we had this scenario.

657
00:30:12,290 --> 00:30:13,580
I can't really talk too much about it,

658
00:30:13,580 --> 00:30:16,940
but where we...

659
00:30:16,940 --> 00:30:18,530
It was an emergency situation

660
00:30:18,530 --> 00:30:20,880
and we had to engage in the simulation.

661
00:30:20,880 --> 00:30:24,190
And, I had to, at one point,
I had to tell myself, okay,

662
00:30:24,190 --> 00:30:25,860
Sarah, this is not real.

663
00:30:25,860 --> 00:30:27,680
Like I got a little like... (screaming)

664
00:30:27,680 --> 00:30:30,300
And, I was like, okay, this is not real,

665
00:30:30,300 --> 00:30:32,110
but I'm gonna do it, because I...

666
00:30:32,110 --> 00:30:34,890
No one's getting hurt
is what I was thinking.

667
00:30:34,890 --> 00:30:36,200
No one's getting hurt.

668
00:30:36,200 --> 00:30:38,240
So, this is not real.

669
00:30:38,240 --> 00:30:39,360
No one's gonna die.

670
00:30:39,360 --> 00:30:42,520
So, okay.

671
00:30:42,520 --> 00:30:43,550
I'm gonna start.

672
00:30:43,550 --> 00:30:46,080
A couple things I just wanna mention,

673
00:30:46,080 --> 00:30:49,940
I put it in my announcement,
but April 12th, after class,

674
00:30:49,940 --> 00:30:51,770
we'll do a group review.

675
00:30:51,770 --> 00:30:53,313
It's not mandatory.

676
00:30:54,415 --> 00:30:57,533
I'm just gonna do a full review
of the exam for everybody.

677
00:30:59,090 --> 00:31:00,590
So, hopefully that helps everybody.

678
00:31:00,590 --> 00:31:05,590
And, plus, Dan and I spend like
hours meeting with students

679
00:31:05,600 --> 00:31:07,990
between the first and the second exam.

680
00:31:07,990 --> 00:31:11,023
And, that just ate up a
lot of our grading time,

681
00:31:12,370 --> 00:31:13,230
which is fine.

682
00:31:13,230 --> 00:31:14,790
It was fine that we met with you,

683
00:31:14,790 --> 00:31:19,270
but it's just a lot of our
time was taken for that.

684
00:31:19,270 --> 00:31:22,240
And, we wanna make sure
that we stay up to...

685
00:31:22,240 --> 00:31:23,440
On track with grading,

686
00:31:23,440 --> 00:31:26,810
we wanna make sure that
we prepare sufficiently

687
00:31:26,810 --> 00:31:28,230
for lectures and stuff like that.

688
00:31:28,230 --> 00:31:30,470
So, I know, I know we have guest speakers,

689
00:31:30,470 --> 00:31:32,450
but we still work with the guest speakers,

690
00:31:32,450 --> 00:31:36,490
and meet with them, and
look over their content.

691
00:31:36,490 --> 00:31:40,010
So, it's all this time
that we just wanna save,

692
00:31:40,010 --> 00:31:42,290
but also give everybody opportunity

693
00:31:42,290 --> 00:31:45,400
to review the exam all together, okay?

694
00:31:45,400 --> 00:31:46,850
So, hopefully that helps you.

695
00:31:48,488 --> 00:31:50,780
And, I already asked my
other questions, so, okay.

696
00:31:50,780 --> 00:31:52,950
I'm gonna, you can go
off video if you'd like,

697
00:31:52,950 --> 00:31:54,673
I'm gonna start recording again.

698
00:31:57,898 --> 00:31:58,753
Okay.